Management of Allergic Rhinitis with Partial Response to Initial Treatment

Evaluation of Current Treatment

The American Academy of Allergy, Asthma, and Immunology recommends that intranasal corticosteroids are the most effective therapy for controlling all symptoms of allergic rhinitis, surpassing oral antihistamines significantly 1, 2
The American College of Allergy, Asthma, and Immunology suggests that mometasona should be used continuously and daily, not intermittently, to achieve optimal efficacy 1
Oral antihistamines have a limited effect on nasal congestion and are less effective than intranasal corticosteroids 1

The American Academy of Otolaryngology recommends instructing patients to direct the spray away from the nasal septum to minimize irritation and bleeding 2
Evaluating response after 2-4 weeks of continuous use is recommended 3
Adding an intranasal antihistamine (azelastina) to the regimen of intranasal corticosteroids can provide superior reduction of symptoms (37.9%) compared to intranasal corticosteroids alone (29.1%) 3, 4

The American Academy of Allergy, Asthma, and Immunology suggests that montelukast may be added to antihistamines with an additive effect, although it is less effective than intranasal corticosteroids 1
Montelukast is especially useful if there is concomitant asthma 5
Ipratropium bromide intranasal is effective specifically for rhinorrhea 2, 4
The combination of ipratropium bromide with intranasal corticosteroids is more effective than either alone without increasing adverse effects 4

Consider referral to an allergist/immunologist if symptoms persist after 2-4 weeks of optimal pharmacological therapy 3
Immunotherapy with allergens (subcutaneous or sublingual) may be considered in patients with inadequate response to pharmacotherapy 4
Immunotherapy can prevent new allergic sensitizations and reduce the risk of developing asthma 4

The American Academy of Allergy, Asthma, and Immunology recommends not using intranasal corticosteroids intermittently or "as needed" - they should be used daily 1
The American College of Allergy, Asthma, and Immunology advises not to prolong topical decongestants for more than 3 days - risk of rhinitis medicamentosa 1, 2, 3
The American Academy of Otolaryngology recommends not using parental corticosteroids - contraindicated due to risk of long-term systemic adverse effects 2, 4